Human Resource Management Project

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Case Assignment # 2: The Design of a PFP System for Mega Manufacturing Overview This exercise evaluates the feasibility of different ap- proaches to PFP given the strategic plan of the organiza- tion. As discussed in the chapter, the effectiveness of the PFP system depends on a number of factors. This exercise will give the student the opportunity to consider some of these factors in proposing an ideal PFP system. Learning Objectives After completing this exercise, you should be able to 1. Identify the key organizational variables that should be considered in the development and/or revision of a PFP system. 2. Understand the role and importance of other HRM activities (e.g., job analysis, performance appraisal) in the development of a PFP system. Procedure Part A: Individual Analysis Step 1. Read the scenario that follows. Step 2. You have been retained as a consultant who must report to Ellen Lennett, director of incentive program development at Mega Manufacturing corporate headquarters. You will be working with the Kanto division. You have been asked to address the five issues raised on Form 11.1.1. Respond to each of the issues and recommend a specific program that supports both Mega’s incentive policy and Kanto’s situation. Your recommendation should consider at least the five points. Also, complete the Assessment Questions form. What were the key variables you considered in your selection of an individual- or group-based PFP system? What changes in organizational characteristics would seriously affect your recommendations? What circumstances would lead you to conclude that a PFP system would not be in the best interests of the organization? YOU WILL SUBMIT YOUR INDVIDUAL ANALYSIS TO THE “INDIVIDUAL ANALYSIS OF CASE 2” SUBMISSION LINK ON THE ASSIGNMENTS PAGE. The two memos in Exhibits 11.1.1 and 11.1.2 may be relevant to the recommendations you will make. Ellen Lennett has received the notes, one from Don Walker, vice president, compensation and benefits, and the other from Bill Idrey, a compensation specialist she sent to help the Kanto personnel department. Part B: Group Analysis Step 1. In groups, each member should review the individual reports and take notes on the most important points. Each member also should devise his or her own strategy for identifying the best group response to make for each of the five questions presented in Form 11.1.1 plus any additional issues the group considers to be relevant. The group also should devise a list of key questions that must be answered by management before a firm position can be taken on the elements of the PFP system.

 

 

Step 2. ONE group member should be designated to submit a five-page paper listing the recommended questions and summarizing alternative recommendations. SUBMIT TO “GROUP CASE ANALYSIS 2” TURNITIN SUBMISSION LINK ON THE ASSIGNMENTS PAGE. Scenarios Mega Manufacturing International is a large diversified company with its corporate headquarters in Boston and manufacturing plants, research and development facilities, and distribution and marketing centers in the United States and around the world. Mega Manufacturing is pursuing a long-range strategy of producing high-technology products for three markets: military, industrial, and retail consumer. Because of the intense competitive pressures in its chosen arenas, Mega Manufacturing believes it must obtain the maximum effort from its personnel. In support of this belief, Mega Manufacturing has adopted a policy of paying for performance (PFP). Typically, many of its divisions have incentives comprising a substantial portion of executive pay (40 percent to 150 percent of base pay possible in various types of incentives) and a significant portion of supervisory and employee compensation (5 percent to 25 percent possible). To expand its capabilities in the new electronic surface- mount technology, Mega Manufacturing acquired GW Industries, which had several plants producing high-quality surface-mount electronic parts. The Kanto assembly plant was part of GW Industries; however, it was an older plant producing electronic parts for an industrial process rapidly approaching obsolescence. Although the products were produced on an assembly line, individual workers had relatively little contact with each other, and the skills required were relatively low. Kanto had been a profitable operation for GW, but Mega Manufacturing has to switch Kanto to a different product and process or close the plant. Kanto has a reputation for paying average to below- market wages, but it was viewed as a dependable and stable employer with a good benefits package. As a consequence, Kanto has had a stable and loyal workforce; but with the buyout of GW and the consequent uncertainty surrounding Kanto’s future, there has been talk of unionizing and some of the more skilled employees are known to be seeking other jobs. Mega has decided to offer Kanto the opportunity to manufacture an extremely complex switching device for a military contract. Although the total manufacturing process is complex, it can be broken into steps, with each step consisting of individual skills that can be learned relatively quickly. Groups of individuals, each with a specific skill, will have to work closely together to achieve the required quality levels for each step in the switching device assembly. The nature of the process is such that each individual will have to take an active interest in the success of the assembly or the device will be unsatisfactory. The two memos in Exhibits 11.1.1 and 11.1.2 may be relevant to the recommendations you will make. Ellen Lennett has just received the following notes, one (Exhibit 11.1.1) from Don Walker, vice president, compensation and benefits, and the other (Exhibit 11.1.2) from Bill Idrey, a compensation specialist whom Ms. Lennett sent to help the Kanto personnel department.

 

 

 

Exhibit 11.1.1

TO: Ellen

Lennett SUBJECT:

Kanto incentive

program FROM:

Don Walker

Ellen,

 

We need to give Kanto some more help on setting up its incentives to

adequately support the new switching assembly process. We cannot allow the

conversion process to delay our completing switching assemblies as there is

a large late delivery penalty. Also, Bids and Contracting apparently goofed

and bid too low on the contract to maintain our usual margins. It appears

we have to make up 3% somewhere.

 

 

 

Exhibit 11.1.2

TO: Ellen

Lennett SUBJECT:

Kanto Incentive

Program FROM:

Bill Idrey

Just a quick note to advise you of some early problems I’m encountering. 1. The employees are learning the new skills, but the supervisors are

having trouble (resisting?) learning the necessary composite skills. 2. The parts we’re getting from our Indonesian plant will sometimes test OK

individually, but not work in the final assembly. It apparently is not feasible to test the intermediate assembly steps.

3. Although job analysis says the steps and tasks are essentially equal, two of the assembly steps are perceived as being more important and thus as having higher status by the workers.

4. Robert Horne, the plant manager, is complaining that the new final quality check supervisor, Beatrice Inggold, is too strict and will slow down production.

5. Engineers from Design & Fabrication come in and watch, occasionally making suggestions, but I’m darned if I can see what they are contributing.

 

 

 

Name: Group:

 

1. Is an incentive program appropriate? Explain your position.

2. If so, should there be one, two, or several plans?

3. Who should be included?

4. What should be the basis for incentive payments?

5. What kinds of incentives should be included?

FORM 11.1.1

 

 

 

 

1. What were the key variables you considered in your selection of an individual- or group-based PFP system?

2. What changes in organizational characteristics would seriously affect your recommendations?

3. What circumstances would lead you to conclude that a PFP system would not be in the best interests of the organization?

EXERCISE 11.1 ASSESSMENT QUESTIONS

 

  • Overview
  • Learning Objectives
  • Procedure
  • Scenarios
 
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You Are The HR Manager For A Commercial Airline. You Have Been Assigned To Develop A Realistic Job Preview For Flight Attendants. Your Objective Is To Give A Balanced Picture Of The Job So That Applicants Will Better Understand What They Will Be Asked To

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You are the HR manager for a commercial airline. You have been assigned to develop a realistic job preview for flight attendants. Your objective is to give a balanced picture of the job so that applicants will better understand what they will be asked to do. Job duties, schedules, and other facets of the job should all be well understood early in the recruiting process to avoid poor P/E fit later on.

A.  How would you gather information about the job context and environment? Explain what sources you would use and why.

B.  How could you use technology to show the positive and negative aspects of the job

 
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Unit III Case Study – Training And Development

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For the case study, we will focus on the importance of safety and all parties helping to make safety a priority. The effectiveness of the safety training will depend on how prepared the participants are for the training and their perception of the training.

Review “Case: Safety First” located in the textbook on page 196, and respond to the prompts below. You are not required to answer the questions at the end of the case study in the textbook.

1. Examine the components of an effective training needs analysis for this scenario. What would the basic parts for a successful training program be?

2. Describe how the training should be delivered, and briefly describe one motivational theory from those listed on pages 161–173 in the textbook and how it supports this type of training to enhance an organization’s performance.

Your case study should be at least three pages in length. You are  required to use APA style for this assignment;  your writing should be clear and concise. Information about accessing the grading rubric for this assignment is provided below.

Unit VII Homework

In this homework assignment, you will develop a table on performance appraisals (PA) and how they are applied to training.

In column 1, identify three different types of PAs that can be offered.

In column 2, analyze how the PA can be applied to a training effort.

In column 3, identify one type of training and one assessment tool for each PA that could be used to identify training success.

 
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BUS303 Ashford University Week 2 Assignment – Job Description Paper

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Job Description Paper

The primary function of the job description paper is to increase understanding of your current, or a prospective, position. The following areas of the job description should be considered:

Tasks,

Tools and Technology,

Knowledge,

Skills and Abilities,

Educational Requirements.

Submit a paper in which you describe each of the above mentioned areas of the job description from the vantage point of your chosen position. Provide two or more ways that you would advertise or recruit someone for that position (see chapter 4 of the textbook). In addition, include a description of at least two methods of assessment used when recruiting qualified candidates and why these two assessment methods would be most appropriate.

Writing the Job Description Paper:

Must be three double-spaced pages in length, excluding the cover page and reference page, and formatted according to APA style as outlined in your approved style guide.

Must include a cover page with the following:

Name of paper

Student’s name

Course name and number

Instructor’s name

Date submitted

Must include an introductory paragraph with a succinct thesis statement.

Must address the topic of the paper with critical thought.

Must conclude with a restatement of the thesis and a conclusion paragraph.

Must use APA style as outlined in your approved style guide to document all sources.

Must include, on the final page, a Reference List that is completed according to APA style as outlined in your approved style guide and has at least two references in addition to the text.

Carefully review the Grading Rubric (Links to an external site.)Links to an external site. for the criteria that will be used to evaluate your assignment

 
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Case Study And 3 Questions

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Read Case Study 11-2, “Sleeping on the Job,” on pages 426-427 of your textbook. Then, answer the following questions:

  1. Should the company’s treatment of the grievant for the first two “sleeping on the job” incidents influence the outcome in this case? Explain.
  2. Did the Company have just cause to dismiss the grievant for violating safety rules when in each instance cited, the truck was out of gear with the safety brake on?
  3. Is the union’s argument that the grievant just appeared to be “sleeping” creditable in the absence of any testimony of support by the backhoe driver, a fellow union member?

Your response should be a minimum of 150 words per question. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations, and cited per APA guidelines.

 
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BUS 696 Final Paper

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Focus of the Final Paper
In a twelve to fifteen page paper (excluding title page, reference page and appendix), present an initial business plan. Using information from the final paper submitted in your other entrepreneurial concentration courses and following the categories of a strategic audit of a corporation (Appendix 1.A in your textbook), provide information on the following:

  • Business Idea
  • Governance
  • External Environment: Opportunities and Threats
  • Internal Environment: Strengths and Weaknesses
  • Analysis of Strategic Factors
  • Strategic Alternatives and Recommended Strategy
  • Implementation Programs
  • Evaluation and Control Measures
  • Growth Issues
  • Summary
  • At least five peer-reviewed sources are to be used.

Writing the Research Paper
The Final Paper:

  1. Must be twelve to fifteen double-spaced pages in length, and formatted according to APA style as outlined in the Ashford Writing Center.
  2. Must include a title page with the following:
    • Title of paper
    • Student’s name
    • Course name and number
    • Instructor’s name
    • Date submitted
  3. Must begin with an introductory paragraph that has a succinct thesis statement.
  4. Must address the topic of the paper with critical thought.
  5. Must end with a conclusion that reaffirms your thesis.
  6. Must use at least five scholarly sources, including a minimum of two from the Ashford Online Library.
  7. Must document all sources in APA style, as outlined in the Ashford Writing Center.
  8. Must include a separate reference page, formatted according to APA style as outlined in the Ashford Writing Center
 
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Strategic Workforce Planning Analysis

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Strategic Workforce Planning Analysis

(Strategic Workforce Planning Analysis)

questions 

1. Discuss the workforce planning process. After discussing each step, explain what would happen if an organization did not follow the workforce planning process. Explain from the perspective of the employer and the employees. (210 Words)

 

2. Based on the reading in this unit, there are many external sources of information that firms can tap into to forecast the demand for their product. Discuss the five most common types of information that can be used to evaluate general business trends in the economy. Provide an example for each. (210 Words)

 

3. Within staffing planning, there are three questions that need to be addressed. Identify and discuss each question and its components in detail. (210 Words)

 

4. Part of forecasting a firm’s labor supply requires an understanding of current and future skill and competency trends in the labor market. Compare and contrast forecasting the internal labor market and the external labor market. Be certain to discuss key components used within each process. (210 Words)

APA CITATION

REFERENCE:

Phillips, J. M., & Gully, S. M. (2015). Strategic staffing (3rd ed.). Upper Saddle River, NJ: Pearson

Strategic Workforce Planning Analysis

Staffing and Labor Forecasting Paper

Workforce Planning Process

Firstly, workforce planning involves environmental scanning to identify internal and external trends. Secondly, forecasting workforce demand predicts needed positions based on strategic objectives. Thirdly, forecasting workforce supply assesses current employee skills and future availability. Fourthly, gap analysis compares demand and supply projections to identify shortages or surpluses. Fifthly, solution implementation addresses identified gaps through recruitment, training, or redeployment. Finally, monitoring and evaluation ensure plan effectiveness and enable timely adjustments.

If an organization skipped environmental scanning, strategic threats might go unnoticed. Consequently, forecasting demand would lack precision, causing understaffing or overstaffing. Moreover, ignoring supply assessments could overlook employee retirements or promotions. Therefore, gap analysis would fail to guide recruitment or training correctly. In turn, solution implementation would be misaligned with actual needs. Finally, without evaluation, the organization cannot measure success or correct course.

From the employer perspective, bypassing workforce planning leads to skill mismatches. Hence, project delays and higher labor costs may occur. Additionally, legal risks might increase when staffing levels do not comply with regulations. Moreover, staffing inefficiencies hinder productivity and reduce profitability.

Employees also experience negative outcomes. Firstly, understaffed teams face excessive workloads and burnout. Secondly, overstaffed units may see unclear roles and diminished job satisfaction. Moreover, limited communication channels may foster uncertainty and lower morale. Thirdly, limited development opportunities reduce engagement. Ultimately, employees may leave, increasing turnover and harming organizational culture.

External Information Sources

Firstly, economic indicators track macroeconomic performance through measures like gross domestic product. For example, rising gross domestic product signals increased consumer spending potential. Secondly, consumer market surveys gather direct feedback on preferences and purchase intentions. For instance, a smartphone manufacturer might survey buyers on desired battery life. Thirdly, competitor analysis examines rival strategies, pricing, and product offerings. For example, a clothing company may analyze a competitor’s new sustainable line. Fourthly, industry trend reports identify evolving patterns in technology and consumer behavior. For instance, an automotive firm may use an electric vehicle adoption report. Fifthly, government statistics offer reliable data on labor costs, trade volumes, and import trends. For example, a furniture exporter might use import tariff changes to forecast pricing.

Moreover, economic indicators include unemployment rates and inflation measures. Therefore, a retailer could adjust stocking based on predicted consumer confidence shifts. Furthermore, consumer market surveys often involve focus groups and online polls. Consequently, survey data helps firms align product features with customer expectations. Similarly, competitor analysis may involve benchmarking key performance metrics. In contrast, industry trend reports often originate from consultancy firms. Additionally, government labor statistics guide staffing decisions and production capacity planning. Therefore, combining these sources improves forecast accuracy and supports strategic planning. Moreover, using diverse data reduces risk from any single erroneous forecast.

Staffing Planning Questions

Firstly, organizations must ask how many employees they require. Quantity analysis involves headcount projections by department. Firms evaluate workload, production schedules, and turnover rates to estimate needed staff numbers. In addition, firms may use trend analysis and historical headcount data to adjust projections.

Secondly, firms ask what skills and competencies employees should possess. Skill analysis covers educational qualifications, technical expertise, and behavioral competencies. This ensures alignment between employee capabilities and job requirements. Moreover, competency mapping helps reveal internal talent pools and development needs.

Thirdly, planners inquire when and where employees will be needed. Timing components include recruitment lead times, training durations, and project deadlines. Location considerations cover geographic distribution and remote work feasibility. Furthermore, planners consider seasonal demands and project-based requirements for precise timing.

Furthermore, balancing these questions reduces labor costs and improves service quality. Consequently, organizations can implement recruitment or training before shortages emerge. Therefore, organizations gain competitive advantage through proactive planning. Ultimately, addressing these three questions fosters efficient and effective staffing practices.

Internal and External Labor Market Forecasting

Internal forecasting examines existing workforce capabilities. Internal processes include skill inventories, performance appraisals, and succession planning. For example, a hospital may track nursing competencies and identify future nursing leaders through performance reviews.

By contrast, external forecasting evaluates outside labor supply and skill trends. Components involve analyzing labor force participation rates, educational output, and occupational outlook data. For instance, a clinic may review nursing graduate numbers entering the market.

Internal forecasting focuses on employee development and mobility. It uses talent management systems and career path analysis to fill upcoming vacancies. Conversely, external forecasting relies on government labor statistics and industry association forecasts. This approach helps anticipate skills shortages and wage pressures.

Moreover, internal forecasts often leverage replacement charts and internal applicant pipelines. In contrast, external forecasts use demographic trends and immigration patterns. Therefore, organizations can plan recruitment campaigns or partnerships with educational institutions. Additionally, internal forecasting ensures retention of institutional knowledge. Meanwhile, external forecasting supports strategic decisions about outsourcing or offshoring. Ultimately, combining both forecasts yields robust staffing strategies that balance internal talent development with external labor market realities.

References

Phillips, J. M., & Gully, S. M. (2015). Strategic staffing (3rd ed.). Upper Saddle River, NJ: Pearson.

 
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Maladaptive Immune Response Mechanisms

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Maladaptive Immune Response Mechanisms

(Maladaptive Immune Response Mechanisms)

Maladaptive Responses to Immune Disorders

Maladaptive responses to disorders are compensatory mechanisms that ultimately have adverse health effects for patients. For instance, a patient’s allergic reaction to peanuts might lead to anaphylactic shock, or a patient struggling with depression might develop a substance-abuse problem. To properly diagnose and treat patients, advanced practice nurses must understand both the pathophysiology of disorders and potential maladaptive responses that some disorders cause.

Consider immune disorders, such as HIV, psoriasis, inflammatory bowel disease, and systemic lupus E. What are resulting maladaptive responses for patients with these disorders?

To prepare:

  • Review Chapter 5 and Chapter 7 in the Huether and McCance text, as well as the Yi, et al, article in the Learning Resources. Reflect on the concept of maladaptive responses to disorders.
  • Select two of the following immune disorders: HIV, psoriasis, inflammatory bowel disease, and/or systemic lupus E (SLE).
  • Think about the pathophysiology of each disorder you selected. Consider the compensatory mechanisms that the disorders trigger. Then, compare the resulting maladaptive and physiological responses of the two disorders.
  • Consider the types of drugs that would be prescribed to patients to treat symptoms associated with these disorders and why.
  • Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Consider how your selected factor might impact the disorder. Then, reflect on how your selected factor might impact the effects of prescribed drugs, as well as any measures you might take to help reduce any negative side effects.

Questions to be addressed in my paper:

  1. A brief description of the pathophysiology of the immune disorders you selected.
  2. Explain how the maladaptive and physiological responses of the two disorders differ.
  3. Then, describe the types of drugs that would be prescribed to patients to treat symptoms associated with these immune disorders and why.
  4. Explain how the factor you selected might impact the pathophysiology of each disorder as well as the effects of prescribed drugs.
  5. Explain any measures you might take to help reduce any negative side effects.
  6. Summary with Conclusion

Maladaptive Immune Response Mechanisms

REMINDERS:

1)      2-3 pages (addressing the 5 questions above excluding the title page and reference page).

2)      Kindly follow APA format for the citation and references! References should be between the period of 2011 and 2016. Please utilize the references at least three below as much as possible and the rest from yours.

3)     Make headings for each question.

RESOURCES:

Readings

  • Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
    • Chapter 5, “Innate Immunity: Inflammation and Wound Healing”This chapter examines how the body responds to injury and infection by exploring the first, second, and third lines of defense. It also covers wound healing and alterations of the wound-healing process.
    • Chapter 6, “Adaptive Immunity”This chapter examines the third line of defense, adaptive immunity. It also covers the roles of antigens and immunogens, the humoral immune response, cell-mediated immunity, and the production of B and T lymphocytes in the immune response.
    • Chapter 7, “Infection and Defects in Mechanisms of Defense”This chapter covers the epidemiology, clinical presentation, and treatment of disorders resulting from infection, deficiencies in immunity, and hypersensitivity. It also examines the pathophysiology of an important immune disorder: HIV/AIDS.
    • Chapter 8, “Stress and Disease”This chapter evaluates the impact of stress on various body systems and the immune system. It also examines coping mechanisms and disorders related to stress.
    • Chapter 39, “Structure, Function, and Disorders of the Integument”This chapter begins with an overview of the structure and function of skin. It then covers effects of aging on skin, as well as disorders of the skin, hair, and nails.
    • Chapter 40, “Alterations of Integument in Children”This chapter covers alterations of the integument that affect children. These include acne vulgaris, dermatitis, infections of the skin, insect bites and parasites, vascular disorders, and other skin disorders.
  • Poole Arcangelo, V., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
    • Chapter 8, “Principles of Antimicrobial Therapy”This chapter covers factors that impact the selection of an antimicrobial treatment regimen. It also examines the clinical uses, adverse events, and drug interactions of various antimicrobial agents, such as penicillin
    • Chapter 12, “Fungal Infections of the Skin”This chapter explores the pathophysiology of several fungal infections of the skin, as well as related drug treatments. It also examines the importance of patient education when managing these infections.
    • Chapter 14, “Bacterial Infections of the Skin”This chapter begins by examining causes of bacterial infections. It then explores the importance of selecting an appropriate agent for treating bacterial infections.
    • Chapter 32, “Urinary Tract Infection”This chapter covers drugs used to treat urinary tract infections. It also identifies special considerations when treating geriatric patients, pediatric patients, and women.
    • Chapter 35, “Sexually Transmitted Infections”This chapter outlines the causes, pathophysiology, and drug treatment of six sexually transmitted infections, including gonorrhea, syphilis, and human papilloma virus infection (HPV). It also examines the importance of selecting the proper agent and monitoring patient response to treatment.
    • Chapter 48, “Human Immunodeficiency Virus”This chapter presents the causes, pathophysiology, diagnostic criteria, and prevention methods for HIV. It also covers various methods of drug treatment and patient factors to consider when selecting, administering, and managing drug treatments.
  • Yi, H., Shidlo, A., & Sandfort, T. (2011). Assessing maladaptive responses to the stress of being at risk of HIV infection among HIV-negative gay men in New York City. Journal of Sex Research, 48(1), 62–73.
    Retrieved from the Walden Library databases.This study assesses behaviors and attitudes toward HIV based on knowledge about infection and advances in medical treatment. It also examines the impact of maladaptive responses to the stress of HIV risk.
  • Scourfield, A., Waters, L., & Nelson, M. (2011). Drug combinations for HIV: What’s new? Expert Review of Anti-Infective Therapy, 9(11), 1001–1011. Retrieved from http://www.expert-reviews.com/doi/abs/10.1586/eri.11.125 

    This article examines current therapies and strategies for treating HIV patients. It also examines factors that impact the selection of therapy, including drug interactions, personalization of therapy, costs, management of comorbidities, and patient response.

  • Drugs.com. (2012). Retrieved from www.drugs.comThis website presents a comprehensive review of prescription and over-the-counter drugs, including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

Media

  • Laureate Education, Inc. (Executive Producer). (2012b). Antimicrobials. Baltimore, MD: Author.This media presentation outlines principles of antimicrobial therapy.

Optional Resources

 
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Skin Cancer and Evolution

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Skin Cancer and Evolution

(Skin Cancer and Evolution)

Biology Questions On Cancer

1. What are the causes of skin cancer?

2. Why are Caucasians more at risk of skin cancer than other populations?

3. At what age does skin cancer typically occur? Is the incidence of skin cancer greater in youth or old age?

4. Does the amount of UV light reaching the Earth vary in a predictable manner (Figure 6-3)? If so, describe the pattern you observe.

5. What latitude receives the greatest amount of UV light (Figure 6-3)? The least?

6. Based on these data (Figure 6-3), where might you expect to find the most lightly pigmented and most darkly pigmented people on the planet? Be as specific as you can.

7. Provide a rationale to your answer above (i.e., why did you think that more darkly pigmented people would be found in those areas)?

8. Interpret Figure 6-4 and the trend it describes.

A. Is skin reflectance randomly distributed throughout the globe? If not, how would you describe the pattern?

B. Restate your findings in terms of skin color and UV light (instead of skin reflectance and latitude).

C. How closely do these findings match the predictions of your hypothesis (Question 6)?

D. Some populations have skin colors that are darker or lighter than predicted based on their loca­tion. Their data point falls somewhere outside of the line shown in (Figure 6-4). What might ex­plain the skin color of these exceptional populations? Propose a few hypotheses.

E. Hypothesize why different skin colors have evolved.

(Skin Cancer and Evolution)

9. Hypothesize why different skin colors have evolved. Based on what you know, what factor is most likely to exert a selective pressure on skin color?

10. Review your answer to Question 3. Keeping your answer in mind, how strong a selective pressure do you expect skin cancer (UV-induced mutations) to exert on reproductive success?

11. Based on this information, does your hypothesis about the evolution of skin color (Question 9) seem likely? Why or why not? How does skin color meet, or fail to meet, the three requirements of natural selection outlined above?

12. Based on Branda and Eaton’s results (Figure 6-5), what is the apparent effect of UV light exposure on blood folate levels?

13. What is the apparent effect of UV light on folate levels in these test tubes? __________________

14. How is folate linked to natural selection?

15. All other things being equal, which skin tone would you expect to be correlated with higher levels of folate? _________________________________________________________________________

16. Based on this new information, revise your hypothesis to explain the evolution of human skin color.

17. What would happen to the reproductive success of:

A.light-skinnedperson living in the tropics? _________________________________________

B. light-skinned person living in the polar region? _____________________________________

C.dark-skinned person living in the tropics? _________________________________________

D.  dark-skinned person living in the polar region? _____________________________________

18. Predict the skin tones expected at different latitudes, taking folate needs into consideration. Use the world map (Figure 6-6) to indicate the skin tone expected at each latitude (shade the areas where populations are darkly pigmented).

19. Can folate explain the variation and distribution of light- and dark-skinned individuals around the world?

20. How is vitamin D linked to natural selection?

21. Which skin tone allows someone to maintain the recommended level of vitamin D? ________________

22. Based on this new information, revise your hypothesis to explain the evolution of the variation and distribution of human skin color.

23. Taking only vitamin D into consideration, what would happen to the reproductive success of:

A. light-skinned person living in the tropics? _________________________________________

B. light-skinned person living in the polar region? _____________________________________

C. dark-skinned person living in the tropics? _________________________________________

D. dark-skinned person living in the polar region? _____________________________________

24. Predict the skin tones expected at different latitudes, taking only vitamin D needs into consider­ation. Use the world map (Figure 6-8) to indicate the skin tone expected at each latitude (shade a region to represent pigmented skin in that population).

25. Can vitamin D alone explain the current world distribution of skin color? ____________________

26. Using principles of natural selection, predict the skin tone expected at different latitudes, taking ul­traviolet exposure, vitamin D, and folate needs into consideration. Use the map (Figure 6-9) to indicate skin tone patterns at different latitudes (shade regions where populations are expected to be darkly pigmented).

27. Are UV light, vitamin D and folate needs sufficient to explain the current world distribution of skin color? ___________________________________________________________________________

28. How might you explain that Inuits, living at northern latitudes, are relatively dark-skinned (much more so than expected for their latitude)? Propose a hypothesis.

29. Conversely, Northern Europeans are slightly lighter-skinned than expected for their latitude. Pro­pose a hypothesis to explain this observation.

 
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NURS6630 Final Exam (2018): Walden University

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 NURS6630 Final Exam (2018): Walden University

 NURS6630 Final Exam (2018): Walden University

QUESTION 1

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? (NURS6630 Final Exam (2018): Walden University)

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs

QUESTION 2

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism?

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics

QUESTION 3

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? (NURS6630 Final Exam (2018): Walden University)

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above.

QUESTION 4

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression?

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent.

QUESTION 5

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient?

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy

QUESTION 6

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax)

QUESTION 7

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe?

A. Strattera B. Concerta C. Daytrana D. Adderall

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? (NURS6630 Final Exam (2018): Walden University)

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient

QUESTION 9

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient?

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency.

QUESTION 10

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? (NURS6630 Final Exam (2018): Walden University)

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening.

QUESTION 11

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly?

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.”

QUESTION 12

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile?

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night.

QUESTION 13

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose:

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. (NURS6630 Final Exam (2018): Walden University)

QUESTION 14

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion?

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue.

QUESTION 15

Which patient will receive a lower dose of guanfacine?

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease

QUESTION 16

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient?

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain

QUESTION 17

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? (NURS6630 Final Exam (2018): Walden University)

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool.

QUESTION 18

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? (NURS6630 Final Exam (2018): Walden University)

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime

QUESTION 19

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands?

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness.

QUESTION 20

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? (NURS6630 Final Exam (2018): Walden University)

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg

QUESTION 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection.

QUESTION 22

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? (NURS6630 Final Exam (2018): Walden University)

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy.

QUESTION 23

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? (NURS6630 Final Exam (2018): Walden University)

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test.

QUESTION 24

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID (NURS6630 Final Exam (2018): Walden University)

QUESTION 25

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” (NURS6630 Final Exam (2018): Walden University)

QUESTION 26

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Clozapine (Clozaril)

Phenytoin (Dilantin)

QUESTION 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain.

QUESTION 28

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above

QUESTION 29

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain? (NURS6630 Final Exam (2018): Walden University)

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin

QUESTION 30

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera)

QUESTION 31

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? (NURS6630 Final Exam (2018): Walden University)

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C

QUESTION 32

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above (NURS6630 Final Exam (2018): Walden University)

QUESTION 33

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.”

QUESTION 34

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone

QUESTION 35

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” (NURS6630 Final Exam (2018): Walden University)

QUESTION 36

Which statement best describes a pharmacological approach to treating patients for impulsive aggression?

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive.

QUESTION 37

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things.

QUESTION 38

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.”

QUESTION 39

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction?

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption.

QUESTION 40

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine

QUESTION 41

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above

QUESTION 42

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation?

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly.

QUESTION 43

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia?

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics

QUESTION 44

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe?

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien)

QUESTION 45

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make?

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane)

QUESTION 46

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP?

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.”

QUESTION 47

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects?

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above

QUESTION 48

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach?

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.”

QUESTION 49

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start?

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms.

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option?

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac)

QUESTION 51

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe?

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin)

QUESTION 52

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication?

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera)

QUESTION 53

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response?

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above.

QUESTION 54

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following?

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents.

QUESTION 55

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider?

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions.

QUESTION 56

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)?

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD.

QUESTION 57

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD?

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only

QUESTION 58

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms:

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia

QUESTION 59

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia?

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil

QUESTION 60

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response?

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.”

QUESTION 61

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors?

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B”

QUESTION 62

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice?

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above

QUESTION 63

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment.

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil.

QUESTION 64

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option?

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro)

QUESTION 65

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff?

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.”

QUESTION 66

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems?

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above

QUESTION 67

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients?

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine.

QUESTION 68

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions?

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal

QUESTION 69

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient?

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres)

QUESTION 70

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following?

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA.

QUESTION 71

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed?

A. Kidney disease stage II B. Obesity C. Cardiovascular disease D. Diabetes type II

QUESTION 72

The PMHNP prescribes an obese patient phentermine (Adipex-p)/topiramate ER (Topamax) (Qsymia), Why is topiramate (Topamax) often prescribed with phentermine (Adipex-P)?

A. Phentermine (Adipex-P) dose can be increased safely when taken with an anticonvulsant. B. Phentermine (Adipex-P) works by suppressing appetite while topiramate (Topamax) acts by inhibiting appetite. C. Topiramate (Topamax) potentiates appetite suppression achieved by phentermine (Adipex-P). D. Topiramate (Topamax) helps prevent the unwanted side effects of phentermine (Adipex-P).

QUESTION 73

The PMHNP is assessing a patient who has expressed suicidal intent and is now stating that he is hearing voices and sees people chasing him. The PMHNP identifies these symptoms to be associated with which of the following?

A. Barbiturate intoxication B. Marijuana intoxication C. “Bath salt” intoxication D. Cocaine intoxication

QUESTION 74

The PMHNP is caring for a patient who openly admitted to drinking a quart of vodka daily. Prior to prescribing this patient disulfiram (Antabuse), it is important for the PMHNP to:

A. Evaluate the patient’s willingness to abstain from alcohol B. Counsel the patient on dietary restrictions C. Obtain liver function tests D. Assess for addiction to opioids

QUESTION 75 An opioid-naive patient is taking MS Contin (morphine sulfate) to treat his pain that is secondary to cancer. Under what circumstances would the PMHNP order naloxone (Narcan) IM/SQ?

A. The patient’s speech is slurred, and he is in and out of sleep. B. The patient’s appetite has decreased from eating 100% of his meal to 50% of his meal. C. The patient complains of not having a bowel movement for 4 days. D. The patient’s vital signs are 98.4F temp, 88 pulse, 104/62 blood pressure, and 8 respirations.

QUESTION 76

When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes No

 

NURS 6630 Midterm Exam (2018): Walden University

QUESTION 1

1.      A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP).

A.

“You have to take your medication to become stable.”

B.

“Most medications will increase the number of neurotransmitters that you already have in the brain.”

C.

“Most medications used in treatment are either increasing or decreasing neurotransmitters that your body already has.”

D.

“Why do you believe that your medication is poison?”

QUESTION 2

1.      Which statement about neurotransmitters and medications is true?

A.

Natural neurotransmitters such as endorphins have been discovered after the development of medications.

B.

Some medications were developed after the discovery and known action of the neurotransmitters in the brain.

C.

Neurotransmitters receive messages from most medications.

D.

The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.

1 points

QUESTION 3

1.      When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:

A.

“In an extreme case such as yours, more than one medication is often needed.”

B.

“Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.

C.

“Medications are often specific to the neurotransmitter(s) they are affecting and, due to more than one neurotransmitter involvement, it is often necessary to use more than one medication to improve symptoms.”

D.

“I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms.”

1 points

QUESTION 4 ?

1.      During gene expression, what must occur prior to a gene being expressed?

A.

Transcription factor must bind to the regulatory region within the cell’s nucleus.

B.

RNA must be converted to mRNA.

C.

The coding region must separate from the regulatory region. This is wrong

D.

RNA polymerase must inhibit the process of changing RNA to mRNA.

1 points

QUESTION 5

1.      While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

A.

Genes impact neuron functioning directly.

B.

Changes made to proteins lead to changes in behavior.

C.

Neurons are able to impact protein synthesis.

D.

Genes impact the DNA of a cell, leading to changes in behavior.

1 points

QUESTION 6

1.      Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:

A.

Neurotransmission that occurs via the axon allows for transport of a neurotransmitter.

B.

Active transport is a different type of energy that allows the transport of certain neurotransmitters.

C.

Neurotransmitters can spread by diffusion.

D.

The postsynaptic neuron can release the neurotransmitter.

1 points

QUESTION 7

1.      Why is the cytochrome P450 enzyme system of significance to the PMHNP?

A.

The kidneys play a role with excretion of the medication, and if a patient has kidney damage, the dose must be increased to be effective.

B.

The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer

C.

The medication’s chemical composition changes when it comes in contact with the acid in the stomach.

D.

The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.

1 points

QUESTION 8

1.      It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true?

A.

About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.

B.

The term polymorphic refers to the body’s ability to break a medication down several ways, and this patient may require higher doses of certain antidepressants and antipsychotics.

C.

About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics.

D.

Most enzyme pathways do not have interactions between the newer medications.

1 points

QUESTION 9

1.      As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?

A.

Most medications that act on G-protein linked receptors have antagonistic traits.

B.

The majority of medications used in practice are full agonists and are used to stimulate the body’s natural neurotransmitters.

C.

Most medications act as partial agonists because they allow the body to use only what is needed.

D.

Medications used in practice may act as inverse agonists if the dosage is too high.

1 points

QUESTION 10

1.      The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition:

A.

The patient smokes cigarettes.

B.

The patient has hypertension.

C.

The patient has chronic kidney disease, stage 2.

D.

The patient drinks a cup of coffee a day.

1 points

QUESTION 11

1.      A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol), aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best action is to:

A.

Alert staff to possible seizures

B.

Write an order for a different moodstabilizer

C.

Decrease the amount prescribed for aripiprazole (Abilify)

D.

Explain to the patient that it will be more difficult to control his temper

1 points

QUESTION 12

1.      A patient recently transferred following a suicide attempt has a history of schizophrenia, depression, and fibromyalgia. He is currently taking Amitriptyline (Elavil), Lisinopril, aspirin, and fluoxetine (Prozac). Which is the best action for the PMHNP to take for this patient?

A.

Review Amitriptyline (Elavil) level

B.

Order a liver function test

C.

Check the patient’s blood pressure and pulse

D.

Order a stat platelet count

1 points

QUESTION 13

1.      A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and neurotransmitter serotonin. What is the rationale for prescribing a medication such as this?

A.

To promote the availability of serotonin

B.

To decrease serotonin

C.

To indirectly increase the amount of dopamine in the body

D.

To help decrease the amount of serotonin and dopamine

1 points

QUESTION 14

1.      The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

A.

“I have trouble staying asleep in the middle of the night.”

B.

“My spouse told me that I seem to have trouble remembering things sometimes.”

C.

“I really want to stop smoking, but the cravings are too strong.”

D.

“I feel nervous to go outside and be in large crowds.”

1 points

QUESTION 15

1.      Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is curious about the effects of the drug and how it will act on her symptoms. Which statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s prescription?

A.

“The drug will have an almost immediate effect.”

B.

“The drug can take a while to build up in your system.”

C.

“The drug is slow to release but lasts for a long time.”

D.

“The drug will make a subtle difference in your symptoms.”

1 points

QUESTION 16

1.      A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?

A.

Benzodiazepine

B.

Mirtazapine (Remeron)

C.

Ketamine

D.

Varenicline (Chantix)

1 points

QUESTION 17

1.      The PMHNP is caring for a new patient who has been transferred from another office. When meeting with the new patient, the patient reports, “I feel like I am improving with the stabilizers.” The PMHNP immediately recognizes that the patient is describing which kind of drug? (NURS6630 Final Exam (2018): Walden University)

A.

Full agonists

B.

Antagonists

C.

Partial agonists

D.

Inverse agonists

1 points

QUESTION 18

1.      A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?

A.

“The patient needs to have an inverse agonist.”

B.

“The patient could benefit from an anticonvulsant.”

C.

“The patient’s calcium, sodium, chloride, and potassium levels must be regulated.”

D.

“The patient should have a drug that acts on ligand-gated ion channels.”

1 points

QUESTION 19

1.      The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient?

A.

Ligand-gated ion channels with a pentameric structure

B.

Ligand-gated ion channels with a tetrameric structure

C.

Voltage-sensitive ion channels

D.

Anticonvulsants

1 points

QUESTION 20 ?

1.      Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?

A.

“It’s my fault that all of this is happening. I don’t think I could ever forgive myself.”

B.

“I have to talk to the President because I’m the only one who can help him.”

C.

“I’m not sure why that lady is wearing a red jacket since it’s the dogs who need food.”

D.

“I don’t know that I even want to go to that meeting. It doesn’t seem worth it anymore.”

1 points

QUESTION 21

1.      A patient has been treated with a number of novel psychotropic drugs. How is it theoretically possible to identify cognitive improvement in the patient using neuropsychological assessment batteries after the pharmacologic therapy? I did not have this question

A.

Obtaining raw normative metrics and using them to assess functionality

B.

Having the patient report on cognitive function based on personal experiences

C.

Monitoring the patient in a controlled setting

D.

Measuring symptoms of psychosis

1 points

QUESTION 22

1.      Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin wants to start him on a dopamine agonist to help manage and treat his condition. The PHMNP selects this agent because of which action it has on patients like Mr. McCullin?

A.

Dopamine is terminated through multiple mechanisms.

B.

The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.

C.

MAO-B presents in the mitochondria within the presynaptic neuron.

D.

D2 receptors are the primary binding site for dopamine agonists.

1 points

QUESTION 23

1.      Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate?

A.

“Amphetamines may help you, as they can alleviate psychotic conditions.”

B.

“Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you.”

C.

“Amphetamines can cause hallucinations, so I would advise against this type of prescription.”

D.

“Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you.”

1 points

QUESTION 24

1.      The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment approaches. The PHMNP selects a viable treatment that is consistent with the “dopamine hypothesis of schizophrenia.” What action does the PMHNP anticipate this treatment having on the patient?

A.

Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.

B.

Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.

C.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

D.

The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia.

1 points

QUESTION 25

1.      A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease?

A.

Achieving underactivity of the mesocorticol projections to the prefrontal cortex

B.

Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex

C.

Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex

D.

Achieving overactivity of the mesocorticol projections to the prefrontal cortex

1 points

QUESTION 26

1.      The PMNHP is assessing a 29-year-old patient who takes antipsychotics that block D2 receptors. What patient teaching should the PMHNP include related to the possible side effects of this type of drug?

A.

Hypersexuality

B.

Amenorrhea

C.

Dystonia

D.

Tardive dyskinesia

A.

1 points

QUESTION 27

1.      The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the patient that the patient would be placed on a different antipsychotic agent. Which of the following requires the longest transition time for therapeutic benefit?

Olanzapine to clozapine

B.

Asenapine to Risperidone

C.

Aripripazole to ziprasidone

D.

Aripripazole to clozapine

1 points

QUESTION 28

1.      The PMHNP is assessing a patient who has cirrhosis of the liver and anticipates that the patient will be prescribed an antipsychotic. Which medication does the PMHNP suspect will be ordered for this patient?

A.

Quetiapine

B.

Paliperidone

C.

Lurasidone

D.

Clozapine

1 points

QUESTION 29

1.      Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?

A.

Muscarinic antagonists are more likely to cause decreased prolactin levels.

B.

D2 antagonists decrease the likelihood of EPS symptoms.

C.

D2 antagonism is linked to antidepressant properties.

D.

D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.

1 points

QUESTION 30

1.      Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the patient?

A.

An underlying depressive disorder

B.

The recent change of a 2nd generation antipsychotic to a conventional one

C.

The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic

D.

All of the above

1 points

QUESTION 31

1.      The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)?

A.

Long-term use of antipsychotics

B.

Genetic disposition

C.

Age

D.

A and C

E.

All of the above

1 points

QUESTION 32

1.      The student inquires about antipsychotic medications. Which response by the PMHNP describes nthe factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics?

A.

Those that are potent D2 antagonists

B.

Those that are potent D2 antagonists with 5HT2A antagonism properties

C.

D2 receptors that are blocked in the nigrostriatal pathway

D.

Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors

1 points

QUESTION 33

1.      Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he reports positive responses to the medication, stating, “I really feel as though the effects of my depression are going away.” Which receptor action in antipsychotic medications is believed to be the most beneficial in producing the effects described by Mr. Gordon?

A.

5HT2 antagonism

B.

D2 antagonism

C.

Alpha-2 antagonism

D.

D2 partial agonist

1 points

QUESTION 34

1.      A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?

A.

Norepinephrine

B.

Dopamine

C.

Serotonin

D.

A and C

E.

All of the above

1 points

QUESTION 35

1.      Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new PMHNP, after not getting along well with her previous provider. The new PHMNP is reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s prescription based on this documentation?

A.

The patient has an unsustained response to antidepressants.

B.

The patient has antidepressant-induced hypomania.

C.

The patient has a depletion of monoamine neurotransmitters.

D.

The patient has an adverse effect to atypical antipsychotics.

1 points

QUESTION 36

1.      The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy? (NURS6630 Final Exam (2018): Walden University)

A.

Patient with a bipolar I designation

B.

Patient with a bipolar II designation

C.

Patient with a bipolar III designation

D.

None of the above

1 points

QUESTION 37

1.      Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?

A.

The patient may experience paranoid avoidant behavior.

B.

The patient may experience severe depression.

C.

The patient may experience auditory hallucinations.

D.

The patient may experience increased mood cycling.

1 points

QUESTION 38

1.      The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient’s response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment?

A.

The patient has a higher chance of tolerating SSRI/SNRI treatment.

B.

The patient will have a positive response to SSRI/SNRI treatment.

C.

The patient will develop severe mood cycling in response to treatment.

D.

The patient may be less responsive or tolerant to the treatment.

1 points

QUESTION 39

1.      Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh’s serotonin levels?

A.

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

B.

Norepinephrine inhibits 5HT release through a2 receptors.

C.

Norepinephrine inhibits α2 receptors on axon terminals.

D.

Norepinephrine potentiates 5HT release through a1 and a2 receptors.

1 points

QUESTION 40

1.      Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?

A.

“Drugs inhibit the release of NE.”

B.

“Drugs can mimic the natural functioning of the NE neuron.”

C.

“Drugs are unable to simulate the effects of NE neurons.”

D.

“Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron.”

1 points

QUESTION 41

1.      The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants over the course of a year. Which of the following symptoms can be residual symptoms for patients who do not achieve remission with major depressive disorder?

A.

Insomnia

B.

Suicidal ideation

C.

Problems concentrating

D.

A and C

1 points

QUESTION 42

1.      Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

A.

Neuronal firing rates are not dysregulated in depression.

B.

Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

C.

Upon the acute administration of a SSRI, 5HT decreases.

D.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.

1 points

QUESTION 43

1.      The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

A.

Both have a sedative-like, calming effect.

B.

Both contribute to antipsychotic actions.

C.

Both demonstrate favorable findings in treating depression in the elderly.

D.

Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.

1 points

QUESTION 44

1.      A 45-year-old female patient with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed in considering monoamine oxidase inhibitors (MAOI) in treating her depression?

A.

Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

B.

The patient cannot take any antihistamines.

C.

The patient cannot have two wisdom teeth extracted while on a MAnOI.

D.

The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.

1 points

QUESTION 45

1.      After sitting in on an interdisciplinary treatment team meeting, the student nurse asks the instructor to explain a system-based approach to the treatment of depression. What is the appropriate response?

A.

Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.

B.

Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

C.

Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

D.

All of the above.

1 points

QUESTION 46

1.      A 51-year-old female patient presents with symptoms of depression, including lack of motivation and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression?

A.

First onset in puberty or early adulthood

B.

Late onset of menses

C.

Premenstrual syndrome

D.

A and C

1 points

QUESTION 47

1.      A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the PMHNP and asks what the next treatment option could be in this seemingly treatment-resistant patient. The PMHNP tells the nurse she will treat the patient with the following regimen:

A.

MAOI plus SNRI

B.

SSRI/SNRI plus NDRI

C.

NDRI/SNRI plus mirtazapine

D.

NDRI plus modafinil

1 points

*Q/UESTION 48

1.      Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?

A.

She may experience withdrawal symptoms.

B.

She may experience increased trauma.

C.

Effects of abrupt cessation are unknown.

D.

It can lead to difficulties with concentration.

1 points

QUESTION 49

1.      A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?

A.

Weight gain can be problematic.

B.

Sedation is very common.

C.

Induction of mania is rare.

D.

Seizures are not unusual.

1 points

QUESTION 50

1.      The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?

A.

Stop the venlafaxine

B.

Lower the dose of venlafaxine by 50%

C.

Lower the dose of venlafaxine by 25-40%

D.

Increase the dose of venlafaxine by 50%

1 points

QUESTION 51

1.      A 25-year-old female patient is being prescribed milnacipran to treat fibromyalgia, and expresses concern regarding “how she will feel and look” from taking the medicine. Which statement correctly describes the side effects as a result of taking this medication?

A.

It can affect her menstruation.

B.

Suicidality can be common among young adults.

C.

Sedation may be problematic.

D.

Weight gain is unusual.

1 points

QUESTION 52

1.      Mr. Ruby is a 33-year-old single father who is requesting pharmacological intervention to treat his fibromyalgia. The PMHNP sees in the medical chart that he has a recent diagnosis of arrhythmia and a BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40-50 hours a week as a contractor and “manages his stress” by smoking 3-4 cigarettes a day and having 8-10 drinks of alcohol each week. Why would duloxetine be contraindicated for Mr. Ruby?

A.

He has fibromyalgia.

B.

He has arrhythmia.

C.

He uses alcohol.

D.

He is overweight.

1 points

QUESTION 53

1.      A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?

A.

Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.

B.

Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.

C.

Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.

D.

Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose.

1 points

QUESTION 54

1.      A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient?

A.

The patient has hepatic impairment.

B.

The patient has moderate renal impairment.

C.

The patient has severe renal impairment.

D.

The patient has cardiac impairment.

1 points

QUESTION 55

1.      The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?

A.

Histamine H1 receptor blockade can cause insomnia.

B.

Muscarinic M1 receptor blockade causes blurred vision.

C.

Alpha 1 adrenergic receptor blockade causes weight gain.

D.

Muscarinic M3 receptor blockade causes sedation.

1 points

QUESTION 56

1.      A patient who was prescribed an MAO inhibitor is learning about dietary modifications. Which statement made by the PMHNP demonstrates proper teaching of the food-drug interactions for MAO inhibitors?

A.

“You must avoid soy products, such as tofu.”

B.

“You should not consume processed meats.”

C.

“You may consume fermented foods, like sauerkraut.”

D.

“You may continue to drink beers on tap.”

1 points

QUESTION 57

1.      A patient who is prescribed MAO inhibitors asks about whether he can continue taking pseudoephedrine to relieve his congestion. Which response by the PMHNP indicates proper understanding of drug-drug interactions?

A.

“Decongestants are fine to continue taking with MAO inhibitors.”

B.

“Decongestants are okay to take with MAO inhibitors in moderation.”

C.

“Decongestants should be avoided due to risk of serotonin syndrome.”

D.

“Decongestants should be avoided due to risk of hypertensive crisis.”

1 points

QUESTION 58

1.      Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil), and reports “I take my 45 mg pill, three times a day, just like I’m supposed to.” What does the PMHNP understand about this patient? (NURS6630 Final Exam (2018): Walden University)

A.

Ms. Skidmore is taking the correct dose of phenelzine (Nardil).

B.

Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount.

C.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.

D.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.

1 points

QUESTION 59

1.      The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?

A.

Patient with PTSD

B.

Patient with partial seizures

C.

Patient with galactose intolerance

D.

Patient with Lapp lactase deficiency

1 points

QUESTION 60

1.      Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription?

A.

The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

B.

The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.

C.

The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.

D.

The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.

1 points

QUESTION 61

1.      A patient is being prescribed a sedating antidepressant, but is concerned about weight gain. Which medication is most likely to be prescribed to addresses the patient’s concerns?

A.

mirtazapine (Remeron)

B.

doxepin (Silenor)

C.

alprazolam (Xanax)

D.

trazadone (Oleptro)

1 points

QUESTION 62

1.      A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?

A.

Mood stabilizers are only prescribed to treat manic phases of bipolar depression

B.

Mood stabilizers can consistently treat both mania and bipolar depression

C.

Mood stabilizers can target mania and mania relapse and also reduce symptoms of bipolar depression and relapse of bipolar depression symptoms but no drug has been proven to target all four therapeutic actions

D.

Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression

1 points

QUESTION 63

1.      The PMHNP is assessing a patient in the emergency room. The patient shares that he has been on lithium (Lithobid) for many years. What blood tests does the PMHMP order?

A.

Thyroid Stimulating Hormone (TSH)

B.

Complete Blood Count (CBC)

C.

Erythrocyte Sedimentation Rate

D.

Platelet Count

1 points

QUESTION 64

1.      A 39-year old female patient presently on lithium would like to try a new medication to treat her bipolar disorder. She has had concerns about side effects from lithium and wants to learn more about Lamotrigine (Lamictal) as a treatment option. The PMHNP conveys some of the unique aspects of this agent, including which of the following?  I don’t think I had this question

A.

There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer’s disease

B.

Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome

C.

It was one of the first anticonvulsants approved by the FDA to treat bipolar depression

D.

There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age

1 points

QUESTION 65

1.      A nursing student is seeking clarification on the use of anticonvulsants to treat depression and is unclear about most effective outcomes. Which of the following agents does the PMHNP convey as having uncertain outcomes?

A.

Carbamazepine (Tegretol)

B.

Gabapentin (Neurontin)

C.

Valporoic Acid (Depakene)

D.

All of the above

1 points

QUESTION 66

1.      A 46-year old male patient mentions several alternative treatments to Carbamazepine (Tegretol) as a way to manage symptoms of his bipolar depression. Which of the following does the PMHNP indicate would not be an agent to treat bipolar depression? (NURS6630 Final Exam (2018): Walden University)

A.

Omega-3-fatty-acids

B.

Soybean lecithin

C.

Inositol

D.

L-methylfolate

1 points

QUESTION 67

1.      The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which of the following medications is contraindicated for this patient?

A.

Valporic Acid (Depakene)

B.

Carbamazepine (Tegretol)

C.

Lithium (Lithobid)

D.

Lamotrigine (Lamictal)

1 points

QUESTION 68

1.      The PMHNP assesses a 10-year old male child in the ER and suspects mania. Which of the following symptoms and recommendations for follow-up evaluation are appropriate?

A.

Irritability, euphoria, anger; the child should be evaluated further for conduct disorder.

B.

Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD

C.

Irritability, lethargy, anger; the child should be evaluated further for ADHD.

D.

Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder.

1 points

QUESTION 69

1.      A patient was diagnosed with GAD 4 weeks ago and was placed on Clonazepam (klonopin) twice a day and citalopram (citalopram (celexa)) once daily. When he asks the PMHNP why it is necessary to wean him off of the Clonazepam (klonopin) the best response is:

A.

Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain

B.

Clonazepam (klonopin) is not recommended for long term use due to possible sedation

C.

Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)

D.

Clonazepam (klonopin) and citalopram (celexa) target the same area in the brain and after long-term use they will begin to compete making one more or less effective than the other

1 points

QUESTION 70

1.      During assessment a patient states “Why are you asking me about my heart, I am here for my head”, the PMHNP’s best response is:

A.

“Some medications can cause heart issues so it is necessary to rule those out before you begin medication.”

B.

“This is a part of our routine admission and it is important that you give me truthful answers.”

C.

“Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus.”

D.

“Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes.”

1 points

QUESTION 71

1.      The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason: A.

Alcohol is legal and is a common way that most people deal with their problems.

B.

Alcohol works similar to benzodiazepines

C.

Up to 30% of people with anxiety use alcohol to self-medicate

D.

Alcohol increases serotonin at the synapse and the patient may temporarily feel happy

1 points

QUESTION 72

1.      After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?

a.

Respiratory depression

b.

Sedation and restlessness

c.

Sweating and nausea (This question was marked wrong but I think the answers are different too)

d.

Bradycardia and tachypnea

1 points

QUESTION 73

1.      A patient  is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP’s best response is:

A.

“SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry.”

B.

“Even though you were diagnosed with anxiety there is a very high chance that you also have depression due to the similarities of both diseases.”

C.

“Antidepressants are prescribed prophylactically to prevent symptoms of depression.”

D.

“Escitalopram (Lexapro) is very effective with treating the panic attacks that can occur with anxiety.” (NURS6630 Final Exam (2018): Walden University)

1 points

QUESTION 74 ?

1.      The PMHNP evaluates the patient for “fear conditioning” when he asks:

A.

Have you ever experienced any type of trauma?

B.

What do you do when you feel fear?

C.

Does your mother or father have a history of fear and/or worrying?

D.

What makes your fear better?

1 points

QUESTION 75

1.      A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:

A.

He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.

B.

Beta blockers are linked to reconsolidation.

C.

This medication will allow the patient to sleep throughout the night.

D.

This medication is linked to the increase of serotonin in the brain.

See the link for Final Exam Only

https://www.homeworkmarket.com/questions/nurs6630-final-exam-2018-walden-university

See the link for Midterm Exam Only

https://www.homeworkmarket.com/questions/nurs-6630-midterm-exam-2018-walden-university-already-graded-a (NURS6630 Final Exam (2018): Walden University)

References

https://academics.waldenu.edu/catalog/courses/nurs/6630

 
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